ati khaled khalilia

8/9/2019 ATI Khaled khalilia

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ATISUBJECTS FOR THE PRACTICAL EXAMINATION

ANESTHESIA AND INTENSIVE CARE

MEDICINE 4TH

YEAR

Khaled khalilia

4th

year


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SUBJECTS FOR THE PRACTICAL EXAMINATION

ANESTHESIA AND INTENSIVE CARE

MEDICINE 4TH

YEAR

1.1The technique of chest compression.

1.2Desobstruction of the upper respiratory airway in case of liquid foreign bodies.

1.3Desobstruction of the upper respiratory airway in case of solid foreign bodies.

1.4Maneuvers of upper respiratory airway opening in a patient without suspicion of

cervical spine lesion.

1.5Maneuvers of upper respiratory airway opening the upper respiratory airway in

a patient with suspicion of cervical spine lesion.

1.6Evaluation of spontaneous breathing.

1.7Pulse evaluation.

1.8The technique ofmouth to mouth artificial respiration.

1.9Recovery position.

1.10 Defibrillation technique.

2.1 Peripheral venous accessindications, technique, advantages, disadvantages.2.2 Central venous accessindications, technique, advantages, disadvantages.

2.3 Arterial catheterindications, technique, advantages, disadvantages.2.4 Oxygen therapyindications, administration systems, adverse effects.

2.5 Pulse oximetry.2.6 Monitorization of arterial blood pressure.

2.7 Monitorization of body temperature.

2.8 Normal salineindications, advantages, adverse effects.2.9 Ringer lactate solutionindications, advantages, adverse effects.

2.10 Water balance.

2.11 Macromolecular solutions indications, advantages, adverse effects,examples.

2.12 Dopaminemechanism of action, indications, adverse effects.2.13 Dobutaminemechanism of action, indications, adverse effects.

2.14 Adrenalinemechanism of action, indications, adverse effects.2.15 Noradrenalinemechanism of action, indications, adverse effects.

3. Clinical case

Associate Professor Ioana Grigoras, MD, PhD


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1.The technique of chest compression.

Use heel of two hands placed above center of chest (superior to xiphoid). Depress chest at least 4- 5 cm

Compression rate at least 100 times/minute

Compress 30 times within 18 seconds

Compression to Ventilation Ratio 30:2

Depth: 4-6 cm

Frequency: 100/min

Ratio: 30:2

Video :http://www.youtube.com/watch?v=qSsHcdy4GnA

More iformation:http://www.resus.org.au/policy/guidelines/section_13/guideline-13-6dec10.pdf
http://www.youtube.com/watch?v=qSsHcdy4GnAhttp://www.youtube.com/watch?v=qSsHcdy4GnAhttp://www.youtube.com/watch?v=qSsHcdy4GnAhttp://www.resus.org.au/policy/guidelines/section_13/guideline-13-6dec10.pdfhttp://www.resus.org.au/policy/guidelines/section_13/guideline-13-6dec10.pdfhttp://www.resus.org.au/policy/guidelines/section_13/guideline-13-6dec10.pdfhttp://www.resus.org.au/policy/guidelines/section_13/guideline-13-6dec10.pdfhttp://www.youtube.com/watch?v=qSsHcdy4GnA


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2.Desobstruction of the upper respiratory airway in case

of liquid foreign bodies.

Look, listen,feel, ABCDE Abdominal movements, airflow via mouth and nose

Oropharyngeal tube: coma patient

Nasophyryngeal tube.

Tracheal intubation

The Yankauer suctionis anoralsuctioningtool used in medicalprocedures.This tool is used to suctionoropharyngealsecretions in

order to prevent. Remove the liquid,saliva.

Video: yankauer suction:http://www.youtube.com/watch?v=CQ2TN3njTJg
http://en.wikipedia.org/wiki/Mouthhttp://en.wikipedia.org/wiki/Mouthhttp://en.wikipedia.org/wiki/Suction_(medicine)http://en.wikipedia.org/wiki/Suction_(medicine)http://en.wikipedia.org/wiki/Suction_(medicine)http://en.wikipedia.org/wiki/Human_pharynxhttp://en.wikipedia.org/wiki/Human_pharynxhttp://en.wikipedia.org/wiki/Human_pharynxhttp://www.youtube.com/watch?v=CQ2TN3njTJghttp://www.youtube.com/watch?v=CQ2TN3njTJghttp://www.youtube.com/watch?v=CQ2TN3njTJghttp://www.youtube.com/watch?v=CQ2TN3njTJghttp://en.wikipedia.org/wiki/Human_pharynxhttp://en.wikipedia.org/wiki/Suction_(medicine)http://en.wikipedia.org/wiki/Mouth


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3.Desobstruction of the upper respiratory airway in case

of solid foreign bodies. ( i dunno exactly)

Traumatic causes

Laryngeal stenosis Airway burn Acute laryngeal injury

Facial trauma (mandibular or maxillary

fractures)

Hemorrhage

Infections Suppurative parotitis

Retropharyngeal abscess Tonsillar hypertrophy

Ludwigs angina

Epiglottitis Laryngitis

Laryngotracheobronchitis (croup)

Iatrogenic causes

Tracheal stenosis post-tracheostomy Tracheal stenosis post-intubation Mucous ball from transtracheal catheter

Foreign bodies

Vocal cord paralysis

Tumors Laryngeal tumors (benign or malignant)

Laryngeal papillomatosis

TrachealAngioedema

Anaphylactic reactions

C1 inhibitor deficiency Angiotensin-converting enzyme inhibitors

A foreign body may become lodged in the larynx, trachea, or bronchus. The rightbronchus is more commonly affected than the left because of the lesser angle ofdivergence relative to the left bronchus and because of its greater diameter.7,10 Largerforeign bodies may become lodged in the larynx. Laryngotracheal foreign bodies areassociated with increased morbidity and mortality.1

Signs and symptoms associated with foreign body aspiration occur in 3 phases.

Stage 1.Choking, coughing, gasping, and respiratory distress develop because ofairway obstruction. Choking lasts for a few seconds to several minutes after the episodeand may be self-limited.

Stage 2.Acute symptoms may be followed by a temporary quiescent phase in which thepatient may not have any symptoms.

Stage 3.During the last phase, symptoms of complications such as infection maydevelop.

A foreign body that completely obstructs the upper airway is an immediate threatto life and must be removed immediately.

The head-down back-blow maneuver, the first step recommended for infants,combines the force of gravity with the force the chest compression generates toexpel intrathoracic air.

Heimnlich maneuver

cricothyroidoctomy


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4.Maneuvers of upper respiratory airway opening in a

patient without suspicion of cervical spine lesion.

Safe position Head extension

Chin lift

Head lift

Jaw thrust

Mouth opening

Head extension Finger sweep maneuver, remove forign body.

In order to have a better view :

Video 1:http://www.youtube.com/watch?v=etPa9oxVWyUVideo 2:http://www.youtube.com/watch?v=2fnS8mtqzms

Video 3:http://www.youtube.com/watch?v=oTHe8qKoMqo

Video 4:http://www.youtube.com/watch?v=BuXV2ubmf20
http://www.youtube.com/watch?v=etPa9oxVWyUhttp://www.youtube.com/watch?v=etPa9oxVWyUhttp://www.youtube.com/watch?v=etPa9oxVWyUhttp://www.youtube.com/watch?v=2fnS8mtqzmshttp://www.youtube.com/watch?v=2fnS8mtqzmshttp://www.youtube.com/watch?v=2fnS8mtqzmshttp://www.youtube.com/watch?v=oTHe8qKoMqohttp://www.youtube.com/watch?v=oTHe8qKoMqohttp://www.youtube.com/watch?v=oTHe8qKoMqohttp://www.youtube.com/watch?v=BuXV2ubmf20http://www.youtube.com/watch?v=BuXV2ubmf20http://www.youtube.com/watch?v=BuXV2ubmf20http://www.youtube.com/watch?v=BuXV2ubmf20http://www.youtube.com/watch?v=oTHe8qKoMqohttp://www.youtube.com/watch?v=2fnS8mtqzmshttp://www.youtube.com/watch?v=etPa9oxVWyU


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5.Maneuvers of upper respiratory airway opening theupper respiratory airway in a patient with suspicion of

cervical spine lesion.

See the video:http://www.youtube.com/watch?v=DJY89_jC_ZYMore information:http://www.primary-surgery.org/ps/vol2/html/sect0226.html
http://www.youtube.com/watch?v=DJY89_jC_ZYhttp://www.youtube.com/watch?v=DJY89_jC_ZYhttp://www.youtube.com/watch?v=DJY89_jC_ZYhttp://www.primary-surgery.org/ps/vol2/html/sect0226.htmlhttp://www.primary-surgery.org/ps/vol2/html/sect0226.htmlhttp://www.primary-surgery.org/ps/vol2/html/sect0226.htmlhttp://www.primary-surgery.org/ps/vol2/html/sect0226.htmlhttp://www.youtube.com/watch?v=DJY89_jC_ZY


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6.Evaluation of spontaneous breathing.

ABCDE Tension pneumothorax: needle thoracostomy folowed by drainage

Flail chest:ventilitation and stabilization and dressing

Hemothorax: intercostal drain insertion

Pneumothorax:intercostal drain insertion Open pneumothorax: Thoracostomy tube

Pericardial temponade: pericardiocenthesis

Check the following: Look,listen,feel

Lung

Chest wall

Diaphragm

Chest movements

Auscultation Percusion

Airway potency and breathing

.


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7.Pulse evaluation.? (from wikipedia )

Rate:Normal pulse ratesat rest,in beats per minute (BPM)

Children (1-10 years): 70-130Children over 10 years and adults: 60-100

Athletes: 40-60

Rythem: A normal pulse is regular in rhythm and force. Anirregular pulse may be due tosinus arrhythmia,premature

beats,ectopic beats,atrial fibrillation,paroxysmal atrial

tachycardia,atrial flutter,partial heart block etc.

Volume: The degree of expansion displayed by artery duringdiastolic and systolic state is called volume. It also known as

amplitude, expansion or size of pulse.

Hypokinetic pulse:A weak pulse signifies narrowpulse pressure.It may be due to lowcardiac output (as seen inshock,congestive

cardiac failure),hypovolemia,valvular heart disease (such asaortic

outflow tract obstruction,mitral stenosis,aortic arch syndrome)etc

Hyperkinetic pulse: A bounding pulse signifies high pulsepressure. It may be due to lowperipheral resistance (as seen

infever,anemia,thyrotoxicosis,hyperkinetic heart syndrome,A-V

fistula,Paget's diseaseberiberi,liver cirrhosis), increased cardiac

output, increasedstroke volume (as seen in anxiety,

exercise,complete heart block,aortic regurgitation), decreased

distensibility of arterial system (as seen

inatherosclerosis,hypertension andcoarctation of aorta).
http://en.wikipedia.org/wiki/Heart_rate#At_resthttp://en.wikipedia.org/wiki/Sinus_arrhythmiahttp://en.wikipedia.org/w/index.php?title=Premature_beats&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Premature_beats&action=edit&redlink=1http://en.wikipedia.org/wiki/Ectopic_beatshttp://en.wikipedia.org/wiki/Atrial_fibrillationhttp://en.wikipedia.org/w/index.php?title=Paroxysmal_atrial_tachycardia&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Paroxysmal_atrial_tachycardia&action=edit&redlink=1http://en.wikipedia.org/wiki/Atrial_flutterhttp://en.wikipedia.org/w/index.php?title=Partial_heart_block&action=edit&redlink=1http://en.wikipedia.org/wiki/Pulse_pressurehttp://en.wikipedia.org/wiki/Cardiac_outputhttp://en.wikipedia.org/wiki/Shock_(circulatory)http://en.wikipedia.org/wiki/Congestive_cardiac_failurehttp://en.wikipedia.org/wiki/Congestive_cardiac_failurehttp://en.wikipedia.org/wiki/Hypovolemiahttp://en.wikipedia.org/wiki/Valvular_heart_diseasehttp://en.wikipedia.org/w/index.php?title=Aortic_outflow_tract_obstruction&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Aortic_outflow_tract_obstruction&action=edit&redlink=1http://en.wikipedia.org/wiki/Mitral_stenosishttp://en.wikipedia.org/wiki/Aortic_arch_syndromehttp://en.wikipedia.org/wiki/Peripheral_resistancehttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Anemiahttp://en.wikipedia.org/wiki/Thyrotoxicosishttp://en.wikipedia.org/w/index.php?title=Hyperkinetic_heart_syndrome&action=edit&redlink=1http://en.wikipedia.org/wiki/Arteriovenous_fistulahttp://en.wikipedia.org/wiki/Arteriovenous_fistulahttp://en.wikipedia.org/wiki/Paget%27s_diseasehttp://en.wikipedia.org/wiki/Liver_cirrhosishttp://en.wikipedia.org/wiki/Stroke_volumehttp://en.wikipedia.org/wiki/Complete_heart_blockhttp://en.wikipedia.org/wiki/Aortic_regurgitationhttp://en.wikipedia.org/wiki/Atherosclerosishttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Coarctation_of_aortahttp://en.wikipedia.org/wiki/Coarctation_of_aortahttp://en.wikipedia.org/wiki/Hypertensionhttp://en.wikipedia.org/wiki/Atherosclerosishttp://en.wikipedia.org/wiki/Aortic_regurgitationhttp://en.wikipedia.org/wiki/Complete_heart_blockhttp://en.wikipedia.org/wiki/Stroke_volumehttp://en.wikipedia.org/wiki/Liver_cirrhosishttp://en.wikipedia.org/wiki/Paget%27s_diseasehttp://en.wikipedia.org/wiki/Paget%27s_diseasehttp://en.wikipedia.org/wiki/Arteriovenous_fistulahttp://en.wikipedia.org/wiki/Arteriovenous_fistulahttp://en.wikipedia.org/w/index.php?title=Hyperkinetic_heart_syndrome&action=edit&redlink=1http://en.wikipedia.org/wiki/Thyrotoxicosishttp://en.wikipedia.org/wiki/Anemiahttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Peripheral_resistancehttp://en.wikipedia.org/wiki/Aortic_arch_syndromehttp://en.wikipedia.org/wiki/Mitral_stenosishttp://en.wikipedia.org/w/index.php?title=Aortic_outflow_tract_obstruction&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Aortic_outflow_tract_obstruction&action=edit&redlink=1http://en.wikipedia.org/wiki/Valvular_heart_diseasehttp://en.wikipedia.org/wiki/Hypovolemiahttp://en.wikipedia.org/wiki/Congestive_cardiac_failurehttp://en.wikipedia.org/wiki/Congestive_cardiac_failurehttp://en.wikipedia.org/wiki/Shock_(circulatory)http://en.wikipedia.org/wiki/Cardiac_outputhttp://en.wikipedia.org/wiki/Pulse_pressurehttp://en.wikipedia.org/w/index.php?title=Partial_heart_block&action=edit&redlink=1http://en.wikipedia.org/wiki/Atrial_flutterhttp://en.wikipedia.org/w/index.php?title=Paroxysmal_atrial_tachycardia&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Paroxysmal_atrial_tachycardia&action=edit&redlink=1http://en.wikipedia.org/wiki/Atrial_fibrillationhttp://en.wikipedia.org/wiki/Ectopic_beatshttp://en.wikipedia.org/w/index.php?title=Premature_beats&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Premature_beats&action=edit&redlink=1http://en.wikipedia.org/wiki/Sinus_arrhythmiahttp://en.wikipedia.org/wiki/Heart_rate#At_rest


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8.The technique ofmouthto mouth artificial respiration.

Assume thatPatient has pulse and CPR is not necessary!!!Resuscitation by inducing artificial respiration consists of two actions:

(1) establishing and maintaining an open air passage from the upperrespiratory tract (mouth,throat, andpharynx)to thenlungs .

(2) exchanging air andcarbon dioxide in the terminal air sacs of the lungswhile theheart is still functioning.

Safe position

Head tilt

Chin lift Jaw thrust

Mouth opening

While keeping the head tilted, seal the victims mouth with your mouthand seal the patients nose with your fingers. Blow air into the mouthfor at least 1 second. You must give two blows initially.

Another thing to consider in providing mouth to mouth in infants.

Considering that they are small, there is no need to pinch the nose.The nose can be sealed by including it in your blows as you blow onthe infants mouth. Make sure also not to put to much air as you blowon infants. Only use the air from your mouth and not from yourdiapraghm.

Video:http://www.youtube.com/watch?v=Lbh7g-m_bwQ
http://www.britannica.com/EBchecked/topic/499856/resuscitationhttp://www.britannica.com/EBchecked/topic/395124/mouthhttp://www.britannica.com/EBchecked/topic/455238/pharynxhttp://www.britannica.com/EBchecked/topic/351473/lunghttp://www.britannica.com/EBchecked/topic/94900/carbon-dioxidehttp://www.britannica.com/EBchecked/topic/258344/hearthttp://www.youtube.com/watch?v=Lbh7g-m_bwQhttp://www.youtube.com/watch?v=Lbh7g-m_bwQhttp://www.britannica.com/EBchecked/topic/258344/hearthttp://www.britannica.com/EBchecked/topic/94900/carbon-dioxidehttp://www.britannica.com/EBchecked/topic/351473/lunghttp://www.britannica.com/EBchecked/topic/455238/pharynxhttp://www.britannica.com/EBchecked/topic/395124/mouthhttp://www.britannica.com/EBchecked/topic/499856/resuscitation


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9.Recovery position.

1. Kneel next to the person. Place

the arm closest to you straight outfrom the body. Position the far

arm with the back of the handagainst the near cheek.

2. Grab and bend the person's far

knee.

3. Protecting the head with onehand, gently roll the person

toward you by pulling the far kneeover and to the ground.

4. Tilt the head up slightly so that

the airway is open. Make sure thatthe hand is under the cheek. Place

a blanket or coat over the person(unless he or she has a heat illness

or fever) and stay close until helparrives.

Infant Recovery Position

Place the infant face down over your arm with the head slightly lower than

the body. Support the head and neck with your hand, keeping the mouth andnose clear. Wait for help to arrive.


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10. Defibrillation technique : check the script for moreinfo


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1. Peripheral venous accessindications, technique, advantages,

disadvantages.

Indication:

Emergency

Operation

Radiology

Hydration

Nutritional

Medication

Cardiac arrest

Blood products

Long term AB-therapy

Complication:

Infection

Phlebitis

Bleeding

Air embolism

infiltration

Advantages:

Simple technique

Short time (quick)

No interruption of chestcompression

Low costDisadvantages:

Long time of drug circulation

Easy to lose venous accessSites:

Upper extremity: Cephalic vein,median cubital or Basilic vein

Low extremity: great

saphenus vein, MedianMarginal Vein

Scalp: Small superficial vein

Technique:

A.ConsiderLocal Anesthesiaat catheter insertion site (Lidocaine)B.Consider limb warming prior to IV cannula insertionC.Immobilize the extremityD.stretch the vein Flex the wrist to extend the dorsal hand veinsE.Apply aTourniquetto proximal veinF.Antiseptic to cannulation siteG.Flush the needle catheter with sterile saline

H.Enter Skin1. Puncture distal to the site2. Enter at 45 degrees with bevel down3. Pull the skin to the side while entering skin4. Avoid entering the vein with needle

I. Cannulate vein, remove the needle and the tourniquet
http://www.fpnotebook.com/Surgery/Pharm/LclSknAnsths.htmhttp://www.fpnotebook.com/Surgery/Pharm/LclSknAnsths.htmhttp://www.fpnotebook.com/Surgery/Pharm/LclSknAnsths.htmhttp://www.fpnotebook.com/ER/Pharm/Trnqt.htmhttp://www.fpnotebook.com/ER/Pharm/Trnqt.htmhttp://www.fpnotebook.com/ER/Pharm/Trnqt.htmhttp://www.fpnotebook.com/ER/Pharm/Trnqt.htmhttp://www.fpnotebook.com/Surgery/Pharm/LclSknAnsths.htm


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Peripheral venous access:Video 1:http://www.youtube.com/watch?v=nVem1__qW14

Video 2:http://www.youtube.com/watch?v=IMSMvAMHfL8

Video 3:http://www.youtube.com/watch?v=9eHimrGgnm4
http://www.youtube.com/watch?v=nVem1__qW14http://www.youtube.com/watch?v=nVem1__qW14http://www.youtube.com/watch?v=nVem1__qW14http://www.youtube.com/watch?v=IMSMvAMHfL8http://www.youtube.com/watch?v=IMSMvAMHfL8http://www.youtube.com/watch?v=IMSMvAMHfL8http://www.youtube.com/watch?v=9eHimrGgnm4http://www.youtube.com/watch?v=9eHimrGgnm4http://www.youtube.com/watch?v=9eHimrGgnm4http://www.youtube.com/watch?v=9eHimrGgnm4http://www.youtube.com/watch?v=IMSMvAMHfL8http://www.youtube.com/watch?v=nVem1__qW14


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2. Central venous accessindications, technique, advantages,

disadvantages.Indication:

Medication

Fluids adm. Bloodtests

Cardiovascular measurements

Long term AB

Long term pain medicaments

Longterm parenteral nutrition

Dialysis

Plasmaphoresis

Complication: Infection

Phlebitis

Bleeding

Air embolism

Infiltration

Pneumothorax

Thrombosis(DVT and vein)

Arrhythmias

Advantages:

Short time of drug circulation

Safe access Longlasting access

Hypertonic solution

Monitor treatment response

Evaluate heart filling (RV)Disadvantages:

Temporary interruption ofcardiac message

Long installation time

Complication rate Require special equipment

Sites of insertion:

Neck: internal jugular vein

Chest: subclavian vein oraxillary vein

Goin: femoral vein

Non tunneled: fixed in place

Tunneled: under the skin, monoluminal,biluminal, triluminal

CathetherInternal jugular vein External Subclavian vein

Axillary veinBrachial vein.


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Central vein access:

Video 1:http://www.youtube.com/watch?v=H3mJjtTk27Q

Video 2:http://www.youtube.com/watch?v=7YRXirk--hoVideo 3:http://www.youtube.com/watch?v=Sgypvr2fNq0

Video 4:http://www.youtube.com/watch?v=LkPCuJKREyo
http://www.youtube.com/watch?v=H3mJjtTk27Qhttp://www.youtube.com/watch?v=H3mJjtTk27Qhttp://www.youtube.com/watch?v=H3mJjtTk27Qhttp://www.youtube.com/watch?v=7YRXirk--hohttp://www.youtube.com/watch?v=7YRXirk--hohttp://www.youtube.com/watch?v=7YRXirk--hohttp://www.youtube.com/watch?v=Sgypvr2fNq0http://www.youtube.com/watch?v=Sgypvr2fNq0http://www.youtube.com/watch?v=Sgypvr2fNq0http://www.youtube.com/watch?v=LkPCuJKREyohttp://www.youtube.com/watch?v=LkPCuJKREyohttp://www.youtube.com/watch?v=LkPCuJKREyohttp://www.youtube.com/watch?v=LkPCuJKREyohttp://www.youtube.com/watch?v=Sgypvr2fNq0http://www.youtube.com/watch?v=7YRXirk--hohttp://www.youtube.com/watch?v=H3mJjtTk27Q


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3. Arterial catheter (arterial line) indications, technique,

advantages, disadvantages.Indication:

Continuous direct blood

pressure monitoringarterial blood gas sampling

Central venous pressure

R.atrium pressure

Pressure in pulmonary artery

Cardiac output

Stroke volume

O2-cosumption and delivery

Vascular resistance

Advantages:Shock diagnosis

Monitor treatment responseDisadvantages:

Complication

Required special equipment

Complication: Infection

Pneumothorax

Hematoma,bleeding

Thrombosis

Aneurysm

FistulaSite of insertion:

Radial artery

Brachial artery Femoral artery

Ulnar artery

Dorsalis pedis artery

Technique:

1. Arm is abducted and the wrist hyperextended

2. Local skin anesthesia is then administered

3. Proximal to styloid process of the radius, a small incision is made over the skin

4. Subcutaneous tissue is then tunneled using forceps

5. At 45 angle, an 18-21 guage needle should be introduced

6. Radial sheath of 23cm long and 4-6Fr size should then be introduced

7. Using a rotating arm board under the shoulder facilitates ease of movement and

placement of radial sheath

8. Through sidearm of the sheath, 5000U ofheparinshould be administered

9. To reduce spasm, 500 micrograms ofdiltiazemcan also be administered

10. Coronary catheters are then advanced along the guidewire into aorta

11. Left and right coronary arteries are then catheterized using Judkins, Amplatz or

multipurpose catheter
http://emedicine.medscape.com/article/1902703-overviewhttp://www.wikidoc.org/index.php/Heparinhttp://www.wikidoc.org/index.php/Heparinhttp://www.wikidoc.org/index.php/Heparinhttp://www.wikidoc.org/index.php/Diltiazemhttp://www.wikidoc.org/index.php/Diltiazemhttp://www.wikidoc.org/index.php/Diltiazemhttp://www.wikidoc.org/index.php/Diltiazemhttp://www.wikidoc.org/index.php/Heparinhttp://emedicine.medscape.com/article/1902703-overview


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12. Hemostasis is achieved by direct pressure at the puncture site at the end of the

procedure after removal of radial sheath

13. Radial pulse should be monitored after the procedure for several hours regularly.

Arterial cathether:More info:http://www.arrowintl.com/documents/pdf/literature/eng-sac-c0507.pdf

Video 1:http://www.youtube.com/watch?v=CLxxM4yltwo

Video 2:http://www.youtube.com/watch?v=6--8J4iqGEY

Video 3:http://www.youtube.com/watch?v=qv54USEYNzw
http://www.arrowintl.com/documents/pdf/literature/eng-sac-c0507.pdfhttp://www.arrowintl.com/documents/pdf/literature/eng-sac-c0507.pdfhttp://www.arrowintl.com/documents/pdf/literature/eng-sac-c0507.pdfhttp://www.youtube.com/watch?v=CLxxM4yltwohttp://www.youtube.com/watch?v=CLxxM4yltwohttp://www.youtube.com/watch?v=CLxxM4yltwohttp://www.youtube.com/watch?v=6--8J4iqGEYhttp://www.youtube.com/watch?v=6--8J4iqGEYhttp://www.youtube.com/watch?v=6--8J4iqGEYhttp://www.youtube.com/watch?v=qv54USEYNzwhttp://www.youtube.com/watch?v=qv54USEYNzwhttp://www.youtube.com/watch?v=qv54USEYNzwhttp://www.youtube.com/watch?v=qv54USEYNzwhttp://www.youtube.com/watch?v=6--8J4iqGEYhttp://www.youtube.com/watch?v=CLxxM4yltwohttp://www.arrowintl.com/documents/pdf/literature/eng-sac-c0507.pdf


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4. Oxygen therapy indications, administration systems,

adverse effects.

chronic indication:

COPD (chronic bronchitis andemphysema)

Breathless patient

Endstage cardiac failure

Endstage respiratory failure

CancerAcute indication:

Emergency, hospital and firstaid

Resuscitation

TraumaAnaphylaxis

Hemorrhage

Shock

Hypothermia

Hypoxemia

Cluster headache

Fire risk

Asthma

PneumoniaRDS

Administration:

Nasal canula 5L/min

Face mask 50 %

Venture mask

Mask+ reservoir Bag 70%

Mask + one way valves 80%

Nasal canula 100%

Very tight masksanesthesiaPocket mask

Bag-valve-mask (cyaidepoisoning)

Filtered o2-mask

Storage and sources:

Liquid and compressed gas


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Oxygen therapy:Video 1:http://www.youtube.com/watch?v=FT7t9hroLLgVideo 2:http://www.youtube.com/watch?v=Nc2zl2SeQNo

Video 3:http://www.youtube.com/watch?v=MNzCfO7Z0Fk
http://www.youtube.com/watch?v=FT7t9hroLLghttp://www.youtube.com/watch?v=FT7t9hroLLghttp://www.youtube.com/watch?v=FT7t9hroLLghttp://www.youtube.com/watch?v=Nc2zl2SeQNohttp://www.youtube.com/watch?v=Nc2zl2SeQNohttp://www.youtube.com/watch?v=Nc2zl2SeQNohttp://www.youtube.com/watch?v=MNzCfO7Z0Fkhttp://www.youtube.com/watch?v=MNzCfO7Z0Fkhttp://www.youtube.com/watch?v=MNzCfO7Z0Fkhttp://www.youtube.com/watch?v=MNzCfO7Z0Fkhttp://www.youtube.com/watch?v=Nc2zl2SeQNohttp://www.youtube.com/watch?v=FT7t9hroLLg


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5.Pulse oximetry:

Pulse oximetryis anon-invasive method for monitoring a patient'sO2saturation.

a sensor is placed on a thin part of the patient's body, usuallyafingertiporearlobe,or in the case of aninfant,across a foot.

The principle of pulse oximetry is based on the red and infraredlight absorption characteristics of oxygenated and deoxygenated

hemoglobin. Oxygenated hemoglobin absorbs more infrared light

and allows more red light to pass through. Deoxygenated (or

reduced) hemoglobin absorbs more red light and allows more

infrared light to pass through. Red light is in the 600-750 nmwavelength light band. Infrared light is in the 850-1000 nm

wavelength light band. (not very important !! general knowledge)

Indication:

Monitor o2-saturation

Sleep disorders

Sleep apnea

Emergency Surgery

COPD

Asthma

Pneumonia

Congestive heart failure

Anemia

Lung cancer

During anaesthesia

Advantages: Detect arrhythmias

Evaluation of A.bloodoxygenation

Measure HR

Evaluate peripheral perfusion

Non-invasive Transportable

Detect ventilation abnormalitiesDisadvantages:

Movementartefacts

Painted nailsdont use

Low accuracy of bloodoxygenation

tissue perfusion pressure

cant measure
http://en.wikipedia.org/wiki/Invasiveness_of_surgical_procedureshttp://en.wikipedia.org/wiki/Fingertiphttp://en.wikipedia.org/wiki/Fingertiphttp://en.wikipedia.org/wiki/Fingertiphttp://en.wikipedia.org/wiki/Earlobehttp://en.wikipedia.org/wiki/Earlobehttp://en.wikipedia.org/wiki/Earlobehttp://en.wikipedia.org/wiki/Infanthttp://en.wikipedia.org/wiki/Infanthttp://en.wikipedia.org/wiki/Earlobehttp://en.wikipedia.org/wiki/Fingertiphttp://en.wikipedia.org/wiki/Invasiveness_of_surgical_procedures


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Pulse oxymetry:

More info:http://windward.hawaii.edu/facstaff/miliefsky-m/ZOOL%20142L/aboutPulseOximetry.pdf

Video 1:http://www.youtube.com/watch?v=9PSXruEjBlY

Video 2:http://www.youtube.com/watch?v=NJwiDz4NquI

Video 3:http://www.youtube.com/watch?v=Tsj7q-CkojI
http://windward.hawaii.edu/facstaff/miliefsky-m/ZOOL%20142L/aboutPulseOximetry.pdfhttp://windward.hawaii.edu/facstaff/miliefsky-m/ZOOL%20142L/aboutPulseOximetry.pdfhttp://windward.hawaii.edu/facstaff/miliefsky-m/ZOOL%20142L/aboutPulseOximetry.pdfhttp://windward.hawaii.edu/facstaff/miliefsky-m/ZOOL%20142L/aboutPulseOximetry.pdfhttp://www.youtube.com/watch?v=9PSXruEjBlYhttp://www.youtube.com/watch?v=9PSXruEjBlYhttp://www.youtube.com/watch?v=9PSXruEjBlYhttp://www.youtube.com/watch?v=NJwiDz4NquIhttp://www.youtube.com/watch?v=NJwiDz4NquIhttp://www.youtube.com/watch?v=NJwiDz4NquIhttp://www.youtube.com/watch?v=Tsj7q-CkojIhttp://www.youtube.com/watch?v=Tsj7q-CkojIhttp://www.youtube.com/watch?v=Tsj7q-CkojIhttp://www.youtube.com/watch?v=Tsj7q-CkojIhttp://www.youtube.com/watch?v=NJwiDz4NquIhttp://www.youtube.com/watch?v=9PSXruEjBlYhttp://windward.hawaii.edu/facstaff/miliefsky-m/ZOOL%20142L/aboutPulseOximetry.pdfhttp://windward.hawaii.edu/facstaff/miliefsky-m/ZOOL%20142L/aboutPulseOximetry.pdf


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6.Monitoring of arterial blood pressure.

Non-invasive:

Palpation: A minimum systolic value can be roughly estimatedbypalpation, most often used inemergency situations, but should be usedwith caution. The diastolic blood pressure cannot be estimated by this method

Auscultation: uses astethoscope and asphygmomanometer. Thiscomprises an inflatable (Riva-Rocci)cuffplaced around the upperarm at

roughly the same vertical height as the heart, attached to a mercuryoraneroidmanometer

Oscilometric:requires less skill than the auscultatory technique and may besuitable for use by untrained staff and for automated patient home monitoring.

CNAP:Continuous Noninvasive Arterial Pressure.

PWV:pulse wave velocityprincipleInvasive:

This technique involves direct measurement of arterial pressure byinserting a cannula needle in a suitable artery. The cannula must be

connected to a sterile, fluid-filled system, which is connected to an

electronic patient monitor. (usuallyradial,femoral,dorsalis

pedis orbrachial). Used inintensive care medicine,anesthesiology.

Advantages:

Blood sample

Repeatable

Real time measurement

Accuracy (high)

Obtain other

Disadvantages:

Complication:ischemia,thrombosis,bleeding,infection.

Require experience

Require special equipment

More info: https://www.inkling.com/read/manual-clinical-anesthesiology-chu-fuller-1st/chapter-11/invasive-arterial-blood

Video 1:http://www.youtube.com/watch?v=WHXP339YjF0

Video 2:http://www.youtube.com/watch?v=5TahRMklod8

Video 3:http://www.youtube.com/watch?v=YM3iXS146Yc
http://en.wikipedia.org/wiki/Palpationhttp://en.wikipedia.org/wiki/Emergency_medical_servicehttp://en.wikipedia.org/wiki/Stethoscopehttp://en.wikipedia.org/wiki/Sphygmomanometerhttp://en.wikipedia.org/wiki/Scipione_Riva-Roccihttp://en.wikipedia.org/wiki/Scipione_Riva-Roccihttp://en.wikipedia.org/wiki/Scipione_Riva-Roccihttp://en.wikipedia.org/wiki/Cuffhttp://en.wikipedia.org/wiki/Armhttp://en.wikipedia.org/wiki/Aneroidhttp://en.wikipedia.org/wiki/Aneroidhttp://en.wikipedia.org/wiki/Continuous_Noninvasive_Arterial_Pressurehttp://en.wikipedia.org/wiki/Continuous_Noninvasive_Arterial_Pressurehttp://en.wikipedia.org/wiki/Pulse_wave_velocityhttp://en.wikipedia.org/wiki/Radial_arteryhttp://en.wikipedia.org/wiki/Femoral_arteryhttp://en.wikipedia.org/wiki/Dorsalis_pedis_arteryhttp://en.wikipedia.org/wiki/Dorsalis_pedis_arteryhttp://en.wikipedia.org/wiki/Brachial_arteryhttp://en.wikipedia.org/wiki/Intensive_care_medicinehttp://en.wikipedia.org/wiki/Anesthesiologyhttps://www.inkling.com/read/manual-clinical-anesthesiology-chu-fuller-1st/chapter-11/invasive-arterial-bloodhttps://www.inkling.com/read/manual-clinical-anesthesiology-chu-fuller-1st/chapter-11/invasive-arterial-bloodhttps://www.inkling.com/read/manual-clinical-anesthesiology-chu-fuller-1st/chapter-11/invasive-arterial-bloodhttp://www.youtube.com/watch?v=WHXP339YjF0http://www.youtube.com/watch?v=WHXP339YjF0http://www.youtube.com/watch?v=WHXP339YjF0http://www.youtube.com/watch?v=5TahRMklod8http://www.youtube.com/watch?v=5TahRMklod8http://www.youtube.com/watch?v=5TahRMklod8http://www.youtube.com/watch?v=YM3iXS146Ychttp://www.youtube.com/watch?v=YM3iXS146Ychttp://www.youtube.com/watch?v=YM3iXS146Ychttp://www.youtube.com/watch?v=YM3iXS146Ychttp://www.youtube.com/watch?v=5TahRMklod8http://www.youtube.com/watch?v=WHXP339YjF0https://www.inkling.com/read/manual-clinical-anesthesiology-chu-fuller-1st/chapter-11/invasive-arterial-bloodhttps://www.inkling.com/read/manual-clinical-anesthesiology-chu-fuller-1st/chapter-11/invasive-arterial-bloodhttp://en.wikipedia.org/wiki/Anesthesiologyhttp://en.wikipedia.org/wiki/Intensive_care_medicinehttp://en.wikipedia.org/wiki/Brachial_arteryhttp://en.wikipedia.org/wiki/Dorsalis_pedis_arteryhttp://en.wikipedia.org/wiki/Dorsalis_pedis_arteryhttp://en.wikipedia.org/wiki/Femoral_arteryhttp://en.wikipedia.org/wiki/Radial_arteryhttp://en.wikipedia.org/wiki/Pulse_wave_velocityhttp://en.wikipedia.org/wiki/Continuous_Noninvasive_Arterial_Pressurehttp://en.wikipedia.org/wiki/Aneroidhttp://en.wikipedia.org/wiki/Aneroidhttp://en.wikipedia.org/wiki/Armhttp://en.wikipedia.org/wiki/Cuffhttp://en.wikipedia.org/wiki/Scipione_Riva-Roccihttp://en.wikipedia.org/wiki/Sphygmomanometerhttp://en.wikipedia.org/wiki/Stethoscopehttp://en.wikipedia.org/wiki/Emergency_medical_servicehttp://en.wikipedia.org/wiki/Palpation


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7.monitoring of body temperature:

Fever:

Infection(pneumonia)

Medication,AB Trauma

Injurey

Heat attack

Burns

Arthritis

Cancer

Hyperthyroidism

Silicosis

SunburnHypothermia:

Cold exposure

Shock

Alcohol

Drugs

Diabetes

Hypothyroidism

SepsisSites of measurements:

Oral cavity (accurate)

Armpit (inaccurate)

Rectal (most accurate)

Axilla

Esophagus

Urinary bladder

Temporal artery

Vagina Ear

Measurements devices:

Mercury thermometer

Digital

infrared

37.0 C (98.6 F)- Normal internal body temperature (which variesbetween about 36.1237.5 C (97.0299.5 F))

35 C (95 F)- (Hypothermiais less than 35 C (95 F)) - Intense shivering,

numbness and bluish/grayness of the skin.

32 C (90 F)- (Medical emergency) Hallucinations, delirium, complete

confusion, extreme sleepiness that is progressively becoming comatose.

39 C (102 F)- (Pyrexia) - Severe sweating, flushed and very red. Fast

heart rate and breathlessness.

41 C (106 F)- (Medical emergency) - Fainting, vomiting, severe

headache, dizziness, confusion, hallucinations, delirium and drowsiness can

occur.

More info about body temperature regulation:

Video 1:http://www.youtube.com/watch?v=ZywM3DN-eo0

Video 2:http://www.youtube.com/watch?v=DrdRIwD2v5g
http://en.wikipedia.org/wiki/Hypothermiahttp://en.wikipedia.org/wiki/Hypothermiahttp://en.wikipedia.org/wiki/Hypothermiahttp://en.wikipedia.org/wiki/Medical_emergencyhttp://en.wikipedia.org/wiki/Medical_emergencyhttp://en.wikipedia.org/wiki/Medical_emergencyhttp://en.wikipedia.org/wiki/Pyrexiahttp://en.wikipedia.org/wiki/Pyrexiahttp://en.wikipedia.org/wiki/Pyrexiahttp://en.wikipedia.org/wiki/Medical_emergencyhttp://en.wikipedia.org/wiki/Medical_emergencyhttp://en.wikipedia.org/wiki/Medical_emergencyhttp://www.youtube.com/watch?v=ZywM3DN-eo0http://www.youtube.com/watch?v=ZywM3DN-eo0http://www.youtube.com/watch?v=ZywM3DN-eo0http://www.youtube.com/watch?v=DrdRIwD2v5ghttp://www.youtube.com/watch?v=DrdRIwD2v5ghttp://www.youtube.com/watch?v=DrdRIwD2v5ghttp://www.youtube.com/watch?v=DrdRIwD2v5ghttp://www.youtube.com/watch?v=ZywM3DN-eo0http://en.wikipedia.org/wiki/Medical_emergencyhttp://en.wikipedia.org/wiki/Pyrexiahttp://en.wikipedia.org/wiki/Medical_emergencyhttp://en.wikipedia.org/wiki/Hypothermia


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8.Normal salineindications, advantages, adverse effects.

Indication:

Iv.infusion (in hypovolemia,no

fluid intake) Contact lense solution

Nasal irrigation

Clean piercing

Flushwounds + skin abrasions

Combined with dextroseglucose

Source of water and electrolytesAdverse effect:

Infection Thrombosis

Phlebitis

Hypervolemia Metabolic acidosis

Interstitial edemaAdvantages:

Easy and available

Reduce risk

CheapContraindication:

Hypertension

Pulmonary edema

Dose: 1.5-3 liter/day

0.9% Sodium Chloride Solution = 9 g/L

Isotonic crystalloid solution

The pH is 5.0 (4.5 to 7.0).

osmolarity = 308 mOsmol/L.

contains 154 mEq/L Sodium and Chloride.

If used to replenish fluids, a large bore IV (18G or more) should be started,hung with a 1000 mL bag of saline.

should be used with great care, if at all, in patients with congestive heartfailure, severe renal insufficiency and in clinical states in which there exists

edema with sodium retention.

check BP and lung sounds every 250cc. Discontinue bolus if pulmonaryedema is discovered, or once BP is in therapeutic range (generally SBP above90 mm/Hg). Avoid hypervolemia.


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9. Ringer lactate solution indications, advantages, adverse

effects:Indication:

in blood loss

trauma surgery

burn

to prevent acidosis

supply water andelectrolytes (e.g.,calcium, potassium, sodium,

chloride)

contraindication:

severe metabolic acidosis

alkalosis

and in severe liver disease anoxic states which affect

lactate metabolism.Adverse effect:

Edema

Infection

Thrombosis

Phlebitis

Hypervolemia

Arrhythmia

pH: 6.2 (6.07.5)

Osmolarity: 275 mOsmol/liter

intravenous administration orsubcutaneously.

Dose: 20-30 ml/kg/hr

Na = 130mmol/L,Cl = 109 ,lactate = 28, K = 4, Ca = 1.5 crystalloids:includesaline anddextrose solutions

This solution should be used with care in patients with hypervolemia, renalinsufficiency, urinary tract obstruction, or impending or frank cardiac

decompensation.
http://www.medicinenet.com/electrolytes/article.htmhttp://en.wikipedia.org/wiki/Intravenous_therapyhttp://en.wikipedia.org/wiki/Subcutaneoushttp://en.wikipedia.org/wiki/Molarity#Molarityhttp://en.wikipedia.org/wiki/Volume_expander#Crystalloidshttp://en.wikipedia.org/wiki/Saline_(medicine)http://en.wikipedia.org/wiki/Intravenous_sugar_solutionhttp://en.wikipedia.org/wiki/Intravenous_sugar_solutionhttp://en.wikipedia.org/wiki/Saline_(medicine)http://en.wikipedia.org/wiki/Volume_expander#Crystalloidshttp://en.wikipedia.org/wiki/Molarity#Molarityhttp://en.wikipedia.org/wiki/Subcutaneoushttp://en.wikipedia.org/wiki/Intravenous_therapyhttp://www.medicinenet.com/electrolytes/article.htm


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10.Water balance: the ratio between the water assimilated into the body and that lost from the body

more info and video:

video 1:http://www.youtube.com/watch?v=mp_3CIUqFU8video 2:http://www.youtube.com/watch?v=QDkLc1GV7Cg

video 3:http://www.youtube.com/watch?v=11a1fXbTf7g
http://www.youtube.com/watch?v=mp_3CIUqFU8http://www.youtube.com/watch?v=mp_3CIUqFU8http://www.youtube.com/watch?v=QDkLc1GV7Cghttp://www.youtube.com/watch?v=QDkLc1GV7Cghttp://www.youtube.com/watch?v=QDkLc1GV7Cghttp://www.youtube.com/watch?v=11a1fXbTf7ghttp://www.youtube.com/watch?v=11a1fXbTf7ghttp://www.youtube.com/watch?v=11a1fXbTf7ghttp://www.youtube.com/watch?v=11a1fXbTf7ghttp://www.youtube.com/watch?v=QDkLc1GV7Cghttp://www.youtube.com/watch?v=mp_3CIUqFU8


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11.Macromolecular solutionsindications, advantages,adverse effects, examples.

Colloid solution

Dextrans: dextran 70, dextran 40Gelatins: Gelofusin, Haemacel, Eufusin

Human albumin 5%, 20%

dimensions between 2 to 1000 nanometers.

Indication:

Hypovolemia

Shock

Spinal anesthesia(prevent hypotension)

Plasma exchange Preoperative/postoperative

Hypoalbuminemia

Prophylaxis (v.thrombosis op)Advantages:

Good volume replacement

Large duration of intravasculat remanence (wtf!!)Disadvantages:

Expensive

Risk of anaphylactic reaction Determine coagulation disorders

Nausea, vomiting

Headache

Interfere with blood groupsdetermination!!

TachycardiaContraindication:

Renal failureCongestive heart failure

(maybe!!)


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12.Dopaminemechanism of action, indications, adverse effects.

Mechanism of action:

5-10 g/kg/min sympathikus:

Heart muscle contraction

heart rate

cardiac output

blood pressure

10-20 g/kg/min Vasoconstriction BP

Vasopressor + Inotropic

Indication:

Hypotension

Bradycardia

Cardiac arrest

Shock (cardiogenic shock)

Heart failureAdverse effect:

Chest pain

Difficult urination

Weakness

Nausea , vomiting

Headache

Difficult breathing

Angina

Irregular heartbeat

azotemia


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13.Dobutaminemechanism of action, indications, adverse effects.

Dose:Continuous infusion: 2.5-15 mcg/kg/min IV

0.5-1 initially, then 2-20 not to exceed 40 mcg/kg/min


Stimulation of 1-receptors (sympathikus):

+ inotropic

contractility

cardiac output

Indication: Heart failure ( R + L ) increase the stroke volume

Cardiogenic shock

Septic shock

Congestive heart failure ( cardiac output )

During heart surgery

Adverse effect:

Hypertension Arrhythmia

Angina

Tachycardia

Palpitation

O2-consumption
http://opencalc%28%27/calculator/dosing/iv-drip-dosing','Low%20Cardiac%20Output','Adult','Continuous%20infusion:%202.5-15%20mcg/kg/min%20IV');http://opencalc%28%27/calculator/dosing/iv-drip-dosing','Low%20Cardiac%20Output','Adult','Continuous%20infusion:%202.5-15%20mcg/kg/min%20IV');


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14. Adrenalinemechanism of action, indications, adverse effects.

Mechanism of action:stimulate 1,1,2 adrenergic receptor:

Relaxation of bronchial smooth muscleCardiac stimulation, HR

Dilation in skeletal muscle

Lung: respiratory rate

Liver: glycogenolysis

Muscle: glycolysis

Dose:1mg every 3-5 min (I.V or intratracheal)

Indication:

Cardiac arrest Anaphylaxis

Bronchospasm

Hypoglycemia

Asthma

Hypotension

Bradycardia

Anaphylactic shock

Glaucoma

Hemostatic In local anesthesia

Adverse effect:

Tachycardia

Palpitation

Arrhythmia

Anxiety

Panic attack

Hypertension

Pulmonary edema Angina pain

Contraindication:

Hyperthyroidism

Ischemic heart disease

Angle-closure glaucoma

Hypertension


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15. Noradrenalinemechanism of action, indications, adverse effects.


: constrictor of blood vessel, BP, Bloodflow high Dose

: Heart (dilate coronary artery) ,inotropic +Small Doseindication:

with local anesthesia

septic shock (for refractory hypotension)

anaphylactic shock

hemostaticadverse effect:

bradycardia

headache

hypertension

diarrhea

dizziness

bleeding

dry skindose:

(initial): 8 to 12 mcg/min -titrate to BP. Usual maintenance: 2 to 4 mcg/min.

doses as high as 0.5 to 1.5 mcg/kg/min for 1-10days have been used inseptic shock.

Calculation of drip rate 8 mg/ 250 ml (ml/hr) = mcg/min x 1.875.Administer through a central line (large vein).

more info:http://www.medsafe.govt.nz/profs/datasheet/n/noradrenalineinf.pdf
http://www.medsafe.govt.nz/profs/datasheet/n/noradrenalineinf.pdfhttp://www.medsafe.govt.nz/profs/datasheet/n/noradrenalineinf.pdfhttp://www.medsafe.govt.nz/profs/datasheet/n/noradrenalineinf.pdfhttp://www.medsafe.govt.nz/profs/datasheet/n/noradrenalineinf.pdf


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Clinical case: Respiratory failure

ARDS

Acute renal failure

Chronic renal failure

Hypovolemic shock

Cardiogenic shock

Septic shock

Anaphylactic shock

Tachycardia, Bradycardia

Acid-base-disturbances

Acidosis: respiratory + metabolic Alcalosis: respiratory + metabolic

Electrolyte disturbances

Hypernatremia

Hyponatremia

Hyperkalemia

Hypokalemia


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Laboratory Test Normal Range in USUnits

Normal Range in SIUnits

ToConvertUS to SIUnits

ALT (Alanineaminotransferase)

W 7-30 units/literM 10-55 units/liter

W 0.12-0.50 kat/literM 0.17-0.92 kat/liter

x 0.01667

Albumin 3.1 - 4.3 g/dl 31 - 43 g/liter x 10

AlkalinePhosphatase W 30-100 units/literM 45-115 units/liter W 0.5-1.67 kat/literW 0.75-1.92 kat/liter x 0.01667

Amylase (serum) 53-123 units/liter 0.88-2.05 nkat/liter x 0.01667

AST (Aspartateaminotransferase)

W 9-25 units/literM 10-40 units/liter

W 0.15-0.42 kat/literM 0.17-0.67 kat/liter

x 0.01667

Basophils 0-3% of lymphocytes 0.0-0.3 fraction of whiteblood cells

x 0.01

Bilirubin - Direct 0.0-0.4 mg/dl 0-7 mol/liter x 17.1

Bilirubin - Total 0.0-1.0 mg/dl 0-17 mol/liter x 17.1

Blood pressure Normal: 120/70 to 120/80 millimeters of mercury(mmHg). The top number is systolic pressure,

when the heart is pumping. Bottom number isdiastolic pressure then the heart is at rest. Bloodpressure can be too low (hypotension) or too high(hypertension).

Noconversion

C peptide 0.5-2.0 ng/ml 0.17-0.66 nmol/liter x 0.33

Calcium, serum 8.5 -10.5 mg/dl 2.1-2.6 mmol/liter x 0.25

Calcium, urine 0-300 mg/24h 0.0-7.5 mmol/24h x 0.025

Cholesterol, totalDesirableMarginalHigh

239 mg/dL6.18 mmol/liter

x 0.02586

Cholesterol, LDLDesirableMarginal

HighVery High

190 mg/dL 4.91 mmol/literx 0.02586

Cholesterol, HDLDesirable >60 mg/dL >1.55 mmol/liter

x 0.02586


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ModerateLow (heart risk)

40-60 mg/dL 1.03-1.55 mmol/liter

Cortisol: serum 0-25 g/dl (depends ontime of day)

0-690 nmol/liter x 27.59

Cortisol: free

(urine)

20-70 g/dl 55-193 nmol/24h x 2.759

Creatine kinase W 40-150 units/liter

M 60-400 units/liter

W 0.67-2.50 kat/liter

M 1.00-6.67 kat/liter

x 0.01667

DHEA W 130-980 ng/dlM 180-1250 ng/dl

W 4.5-34.0 nmol/literM 6.24-43.3 nmol/liter

x 0.03467

DHEASulfate W Pre-menopause: 12-535 g/dlW Post-menopause: 30-260 g/dlM 10-619 g/dl

W Pre-menopause: 120-5350 g/literW Post-menopause: 300-2600 g/literM 100-6190 g/liter

x 10

Eosinophils 0-8% of white blood cells 0.0-0.8 fraction of white

blood cells

x 0.01

Erythrocytesedimentationrate (Sed Rate)

W M W M Noconversion

Folate 3.1-17.5 ng/ml 7.0-39.7 nmol/liter x 2.266

Glucose, urine x 0.05551

Glucose, plasma 70-110 mg/dl 3.9-6.1 mmol/liter x 0.05551

GGT (Gammaglutamyltransferase)

W M W M Noconversion

Hematocrit W 36.0% - 46.0% of red

blood cellsM 37.0% - 49.0% of redblood cells

W 0.36-0.46 fraction of

red blood cellsM 0.37-0.49 fraction ofred blood cells

x 0.01

Hemoglobin W 12.0-16.0 g/dlM 13.0-18.0 g/dl

W 7.4-9.9 mmol/literM 8.1-11.2 mmol/liter

x 0.6206

LDH (Lactatedehydrogenase)(total)

x0.016667

Lactic acid 0.5-2.2 mmol/liter 0.5-2.2 mmol/liter Noconversion

Leukocytes (WBC) 4.5-11.0x103/mm3 4.5-11.0x109/liter No

conversionLymphocytes 16%-46% of white blood

cells0.16-0.46 fraction ofwhite blood cells

x 0.01

Mean corpuscularhemoglobin(MCH)

25.0-35.0 pg/cell 25.0-35.0 pg/cell Noconversion

Mean corpuscularhemoglobin

31.0-37.0 g/dl 310-370 g/liter x 10
http://www.thebody.com/content/art6029.html?ic=4001http://www.thebody.com/content/art6029.html?ic=4001http://www.thebody.com/content/art6029.html?ic=4001


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concentration(MCHC)

MCV (Meancorpuscularvolume)

W 78-102 m3M 78-100 m3

W 78-102 flM 78-100 fl

Noconversion

Monocytes 4-11% of white bloodcells 0.04-0.11 fraction ofwhite blood cells x 0.01

Neutrophils 45%-75% of white bloodcells

0.45-0.75 fraction ofwhite blood cells

x 0.01

Phosphorus 2.5 4.5 mg/dL 0.81-1.45 mmol/L x 0.323

Platelets(Thrombocytes)

130 400 x 10 3L 130 400 x 10 9L Noconversion

Potassium 3.4-5.0 mmol/liter 3.4-5.0 mmol/liter Noconversion

RBC (Red bloodcell count)

W 3.9 5.2 x 106/L3M 4.4 5.8 x 10 6/L3

W 3.9 5.2 x 1012/LM 4.4 5.8 x 10 12/L

Noconversion

Sodium 135-145 mmol/liter 135-145 mmol/liter Noconversion

Testosterone,total (morningsample)

W 6-86 ng/dlM 270-1070 ng/dl

W 0.21-2.98 nmol/literM 9.36-37.10 nmol/liter

x 0.03467

Testosterone, freeAge 20-40

Age 41-60

Age 61-80

W 0.6-3.1,M 15.0-40.0 pg/mlW 0.4-2.5,M 13.0-35.0 pg/ml

W 0.2-2.0,M 12.0-28.0 pg/ml

W 20.8-107.5,M 520-1387 pmol/literW 13.9-86.7,M 451-1213 pmol/liter

W 6.9-69.3,M 416-971 pmol/liter

x 34.67

Triglicerides(fasting)NormalBorderlineHighVery high

40-150 mg/dl150-200 mg/dl200-500 mg/dl>500 mg/dl

0.45-1.69 mmol/liter1.69-2.26 mmol/liter2.26-5.65 mmol/liter>5.65 mmol/liter

x 0.01129

Urea, plasma(BUN)

8-25 mg/dl 2.9-8.9 mmol/liter x 0.357

Urinalysis - pHSpecific gravity 5.0-9.01.001-1.035 5.0-9.01.001-1.035 Noconversion

WBC (White bloodcells, leukocytes)

4.5-11.0x10 3/mm 3 4.5-11.0x10 9liter Noconversion

ati khaled khalilia

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